Reconstrução Mamária com diferentes abordagens do Retalho TRAM / Mammary reconstruction with tram flap conducted with different approaches

Apresentamos quatro casos de reconstrução mamária onde foram utilizadas variantes do retalho TRAM. Com o objetivo de viabilizar os retalhos, foram realizados procedimentos de autonomização, pré-fabricação e para reduzir a morbidade foi utilizado o retalho vertical. As cirurgias tiveram boa execução, os objetivos de reconstituição estética da mama foram atingidos e todos os casos tiveram boa evolução e não constatamos complicações.

The authors present four cases of the use of tram flap and its variants in mammary reconstruction. The autonomization and prefabricated TRAM were made to enhance flap viability. The Drever or vertical flap was made to reduce morbidity. There were no complications, the aesthetic breast reconstruction goals were achieved, the surgery were well conducted and the clinic cases had good evolution.

The open palm technique in severe Dupuytren's contracture

This paper aims to study the author's experience with the open palm technique originally described by McCash for the treatment of serve Dupuytren's contractures. All patients presented hand ulnar border (ring and little fingers) impairment and belonged to stages III to IV of the classification proposed by Tubiana. In a period of 6 years, 35 patients were submitted to regional fasciectomy. On average, 18 days were necessary (extremes of 15 and 25) to complete scar healing. We obtained an average articular residual deficit of 25 to the ring finger and 30 to the little finger at the proximal interphalangeal articulation level.

Incidence of hematoma and seroma in abdominoplasty with and without the use of drains / Incidência de hematoma e seroma em abdominoplastia com e sem o uso de drenos

Based on the experience with 69 patients submitted to abdominoplasty, the authors compare the use of capillary tubes, suction drains and not using drains in the postoperative period as to the effectiveness in preventing hematomas and seromas under the abdominal flap. They also study the association of these fluid collections with known risk factors. They describe the indications and surgical technique employed in their cases and compare results obtained with data available in literature.

Pharyngoesophageal reconstruction: using microsurgical jejunum and pectoralis major flaps / Reconstrução faringoesofágica: utilização do retalho peitoral maior e jejuno microcirúrgico

Pharyngoesophageal reconstruction is one of the majorchallenges of neck surgery. Many treatment options have been described. All of them involve procedures of greater or lesser technical complexity and high ratesof complications and mortality. The present study describes the techniques performed at the Service of Plastic Surgery of the PUC-RS São Lucas Hospital in 10 reconstructions: myocutaneous pectoralis major flap and microsurgical jejunal flap. Indications, complications, advantages and disadvantages of each method are discussed.

Reconstruction of fingertip pulp loss / Reconstrução de perdas de substância digitais distais

loss of valor fingertip pulp is frequent in hand trauma. Eighty-six homodigital flaps (22 Tranquilli; 20 Hueston; 40 Single Pedicle Island and 4 Kutter) were performed from Jannuary 1994 to July 1998, to repair volar fingertip substance loss, except for the thumb. The mean age was 28 years (ranging from 18-58) and the average post-operative follow-up period was 12 months. We analyzed advancements, sensitivity and cold intolerance for each flap used: Tranquilli (0.4cm/8mm/6); Kuttler (0.3cm/10mm/3); Hueston (1.0cm/9mm/5); Single Pedicle Island (1.5cm/8mm/6). The single pedicle island flap was demonstrated to be clearly better in all aspects analyzed. We consider the utilization of homodigital flaps the first choice alternative for reconstruction fingertips. (AU)#TRA